NPIMap

Organization Active NPI

Bulloch County LTC, LLC

Doing business as Eagle Health & Rehabilitation

  • Respite Care
  • Statesboro, GA
National Provider Identifier
1669509865
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
1-016-1802 Issued in GA
Legal business name
BULLOCH COUNTY LTC, LLC
Doing business as
Eagle Health & Rehabilitation
Practice address
405 S College St
Statesboro, GA 30458-5409
Phone
(912) 764-4575
Fax
(912) 764-3916
NPI assigned
Feb 27, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Sheffield
Title
VP of Financial Reporting
Phone
(478) 621-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 1-016-1802 GA Primary

Addresses

Primary practice location

405 S College St
Statesboro, GA 30458-5409

Mailing address

PO Box 746
Statesboro, GA 30459-0746
Phone (912) 764-4575

Other names 1

  • Eagle Health & Rehabilitation Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bulloch County LTC LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669509865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304590746",
            "telephone_number": "912-764-4575",
            "fax_number": "912-764-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S COLLEGE ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585409",
            "telephone_number": "912-764-4575",
            "fax_number": "912-764-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLOCH COUNTY LTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHEFFIELD",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "VP OF FINANCIAL REPORTING",
        "authorized_official_telephone_number": "478-621-2100"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "GA",
            "license": "1-016-1802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.